In reference to an article published in the Daily Journal September 2, 2018 regarding the Mendocino County Behavioral Health System Program Gap Analysis I once more will suggest the following:

1. Probably with grant money, we should create teams of mental health workers. Perhaps we should start with just three teams. Each team would consist of a BA level counselor and a licensed psychiatric technician or a licensed vocational nurse with a mental health background. A licensed social worker should be the team leader. Each team would have 60 clients, 30 for each team member. The BA level worker would use the LVN or psych-tech to assist with medication issues and shot clinics. Their primary responsibility would be to visit clients in their homes, or places where they reside. Weekly visits would be made during the intake period and continue until the client was stable.

2. The licensed certified social worker supervisor would only have a caseload of 15 clients. The primary duty of the supervisor would be to assist the teams with professional decisions regarding care and policy. Periodic meetings should take place where each team presents a case for discussion. Not only would this assist with helping the client, but it would also be a teaching tool for the team members. From a financial point of view, this would give the Community Support Teams the strength of seven licensed social workers in essence, while only having one.

3. A psychiatrist would be involved in all care. Each client would be seen according to a schedule. It would be the duty of the support team psych-tech or LVN to schedule the appointments with the psychiatrist. The LVN or psych-tech would sit in on the meeting with the psychiatrist unless the client objected.

4. Home visits and assistance with daily living is what is necessary to keep a client stable. If one monitors each client on a weekly basis, fewer chances for decompensation occur. Assistance with daily activities can almost take any form of help: shopping for groceries, clothes, looking for a place to live et cetera.

5. Advocacy for the client is also necessary in care. If we do nothing else, we should be an advocate. Our community needs to know about mental illness. Our community needs to know what it can do to help.

I would suggest Community Support Teams in Mendocino County with:

1. A primary clinic housed in Ukiah consisting of three teams of a BA level worker with an LVN and one team leader with an advanced degree. Each team member would have at least 15 clients (maximum 20) and the team leader 5 clients. There would be weekly meetings for all team members to present their most recent admission to all the teams so that each would have some knowledge of the patient condition.

2. A satellite clinic in Fort Bragg with two teams consisting of a BA level worker and one LVN.

3. One psychiatrist would be assigned as the Clinical Support Team doctor to advise and prescribe medication for Ukiah and possibly one for Fort Bragg. Each LVN team member would administer the medication to the clients of his/her team as well as making sure that the client had the proper medication and was taking as prescribed.

How it would work: A client would be referred to the CST Team Leader from a concerned citizen, clinic, emergency room or hospital et cetera. The team leader would then assign the client to one of the two person teams (LVN or BA level counselor). The person assigned would then attempt to contact the client to perform a possible intake. If the client is in crisis, the team member would work with the appropriate people involved and the client would eventually be evaluated for CST follow-up. The counselor would establish a chart that would be kept by the CST in a locked room or if in a building of mental health, a special section that would always be available to CST team members; especially the team member who would be on-call during afterhours, holidays and weekends.

Once a client is established, there would be weekly visits by the assigned team member and the client would become part of that team member’s case load. Ongoing visits would depend on the client’s stability and/or medical condition. At any time that the client becomes unstable and in need of CST help a counselor would make a visit to determine if the client needed to be hospitalized. With five teams having the capacity for 30 clients each, 150 clients could have care in the community. Extending the team case load to 20 would increase the coverage to 200 clients. Having an existing Community Support Team can be a Binding Force that creates better communication between Behavioral Programs so that no client is lost to wander the streets in a helpless vacuum. I challenge the County workers to come up with a better way for now. It has been years of verbal quandaries.